Benzodiazepines

Drugs include	Drug name	Brand name	Street name	Recommended adult daily dose
Hypnotics	Flunitrazepam	Rohypnol	Wallbangers	0.5-1mg

	Flurazepam	Dalmane		15-30 mg
	Nitrazepam	Mogadon	Moggies	5-10mg
	Temazepam	Normison Euhypnos	Jellies, ruggers eggs	125-250
	Triazolam	Halcion	Upjohns	125-250 micrograms
Anxiolotics	Chlordiazepoxide	Librium		30mg
	Diazepam	Valium	Vallies	6mg
	Lorazepam	Ativan		1-4 mg

Street use
Benzodiazepines are swallowed in large numbers and are injected by crushing tablets or injecting jelly or liquid form capsules. Doses of 20 times the recommended therapeutic range have been reported. Benzodiazepines are often mixed with other drugs. The use of Temgesic(an opiate) and temazepam (a benzodiazepine) in combination has been reported in Scotland. The use of temazepam to chill out following the recreational use of ecstasy is also frequently reported.

Drug effects
Depressants (downers). They act on the part of the brain associated with anxiety, reduce tension, and induce sleep. Even at low doses benzodiazepines can affect mental and physical functioning, but less so than alcohol. At higher doses they produce 'drunken' and sometimes aggressive behaviour.

Dependency
At low doses within the therapeutic range, tolerance does not develop to any great extent and only small increases in doses are reported over time. Amongst street users who are using large amounts, tolerance to the sedative effects (but not to the calming effects) develops rapidly and doses escalate.
Dependence can also develop quickly, and some people report withdrawal symptoms after only 4 weeks use at (low) therapeutic doses. The severity of symptoms experienced vary. Amongst long term and heavy users, panic attacks, feelings of unreality, distortion of perceptions, sweating, restlessness and tremor are common.

Withdrawal
Sudden withdrawal from benzodiazepines is dangerous as seizures can occur. Withdrawal should be gradual and conducted under medical supervision. Withdrawal from benzodiazepines can be distressing because symptoms often last for many months.

Long term use
The effects of long term use include mental confusion, memory loss, depression, aggressive behaviour and loss of physical co-ordination. High doses of benzodiazepines for long periods of time can result in poor performance on tasks involving visual-spatial ability and sustained attention. Injecting with dirty needles/syringes and sharing works can cause serious infections such as HIV, hepatitis B and C and blood poisoning. Injecting crushed tablets or gel (from Gelthix¿ capsules) can cause serious circulation problems and, in some cases, loss of limbs. It can also result in injury to the tissue at the injection site, such as abcesses and ulcers. Swollen, inflamed or infected tissue makes it harder to find a vein and users risk hitting an artery.

Overdose risk
Death from overdose is rare because large doses are needed, but the risk increases if benzodiazepines are mixed with other drugs such as opiates, barbiturates or alcohol.

Risk in pregnancy
There is evidence to suggest that some benzodiazepines cause birth defects such as cleft palate, although no harmful effects have yet been reported with temazepam or lorazepam. Withdrawal should be gradual over a few weeks. Babies born to mothers who continue to take benzodiazepines during pregnancy may have withdrawal symptoms which include tremor, irritability, hyperactivity and frantic sucking. Withdrawal symptoms may be more severe than expected from the mother's dose, as the drugs build up in the baby over time.

Legal status
Prescription Only Medicines
Class C, Schedule 4 Part I
Class C, Schedule 3 (temazepam and flunitrazepam)
Illegal to possess without a prescription and to supply to others

Maximum Penalty
Possession: 2 years
Supplying: 5 years